A deductible is the amount a member must pay for eligible healthcare expenses before an insurance plan begins paying for certain covered services. Some plans have separate in-network and out-of-network deductibles, and not every service is treated the same way.
If a client has not met the applicable out-of-network deductible, an eligible therapy claim may be applied to the deductible instead of producing an immediate reimbursement payment. After the deductible is met, the plan may pay a portion of eligible expenses according to its coinsurance and allowed-amount rules. The amount that counts toward a deductible depends on the plan and how the claim is processed.